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支付方式改革强化医保基础性作用

来源: 南方日报网络版     时间: 2019年08月19日 13:09:14
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(一)(直)(以)(来)(,我)(国)(医)(疗)(付)(费)(机)(制)(中)(占)(主)(导)(地)(位)(的)(是)(按)(“项)(目)(付)(费)(”制)(度)(,即)(根)(据)(医)(疗)(机)(构)(诊)(疗)(中)(所)(提)(供)(项)(目)(进)(行)(后)(付)(费)(的)(制)(度)(,此)(种)(“后)(付)(制)(”的)(优)(点)(是)(操)(作)(方)(便)(,但)(与)(医)(疗)(机)(构)(的)(收)(入)(直)(接)(挂)(钩)(的)(特)(点)(,被)(公)(认)(为)(推)(动)(医)(疗)(费)(用)(不)(断)(冲)(高)(的)(原)(因)(之)(一)(。陈)(娟)(认)(为)(,约)(束)(机)(制)(的)(建)(立)(有)(利)(于)(医)(保)(费)(用)(支)(出)(安)(全)(,可)(以)(高)(效)(利)(用)(医)(保)(基)(金)(,合)(理)(分)(配)(利)(用)(医)(疗)(资)(源)(,杜)(绝)(大)(处)(方)(、重)(复)(检)(查)(等)(不)(规)(范)(的)(诊)(疗)(行)(为)(。
显)(然)(,试)(点)(的)(施)(行)(对)(《意)(见)(》明)(确)(推)(广)(按)(病)(种)(付)(费)(改)(革)(积)(累)(了)(经)(验)(并)(奠)(定)(了)(基)(础)(。此)(外)(,在)(各)(地)(方)(选)(择)(一)(定)(数)(量)(的)(病)(种)(实)(施)(按)(病)(种)(付)(费)(的)(同)(时)(,《意)(见)(》要)(求)(,国)(家)(将)(选)(择)(部)(分)(地)(区)(开)(展)(按)(疾)(病)(诊)(断)(相)(关)(分)(组)((DRGs)付)(费)(试)(点)(,鼓)(励)(各)(地)(完)(善)(按)(人)(头)(、按)(床)(日)(等)(多)(种)(付)(费)(方)(式)(。这)(无)(疑)(为)(医)(保)(支)(付)(方)(式)(的)(多)(元)(化)(埋)(下)(了)(重)(要)(伏)(笔)(。
值)(得)(一)(提)(的)(是)(,DRGs(DiagnosisRelatedGroups)即)(“按)(疾)(病)(诊)(断)(相)(关)(分)(组)(”,是)(以)(病)(人)(诊)(断)(为)(基)(础)(的)(一)(种)(分)(类)(方)(案)(。根)(据)(年)(龄)(、疾)(病)(诊)(断)(、合)(并)(症)(、并)(发)(症)(、治)(疗)(方)(式)(、病)(症)(严)(重)(程)(度)(及)(转)(归)(等)(因)(素)(,将)(患)(者)(分)(入)(若)(干)(诊)(断)(组)(。其)(本)(质)(是)(一)(套)(管)(理)(工)(具)(,初)(用)(于)(医)(生)(比)(较)(、医)(疗)(资)(源)(分)(配)(布)(局)(。后)(来)(应)(用)(于)(医)(疗)(保)(险)(支)(付)(而)(被)(广)(泛)(知)(晓)(。迄)(今)(为)(止)(,DRGs也)(是)(国)(际)(上)(公)(认)(的)(最)(合)(理)(的)(支)(付)(方)(式)(之)(一)(。
应)(该)(说)(,无)(论)(是)(按)(病)(种)(付)(费)(还)(是)(DRGs,抑)(或)(是)(按)(人)(头)(、按)(床)(日)(等)(付)(费)(方)(式)(,对)(于)(当)(前)(我)(国)(正)(在)(大)(力)(推)(进)(的)(医)(药)(卫)(生)(体)(制)(综)(合)(改)(革)(而)(言)(,都)(将)(带)(来)(正)(面)(促)(进)(,并)(对)(改)(革)(深)(化)(发)(挥)(综)(合)(积)(极)(效)(应)(。
医)(保)(基)(金)(预)(算)(管)(理)(将)(配)(套)(跟)(进)(
任)(何)(改)(革)(都)(需)(要)(配)(套)(政)(策)(的)(跟)(进)(落)(实)(,对)(于)(医)(保)(支)(付)(改)(革)(而)(言)(尤)(为)(如)(此)(,特)(别)(是)(医)(保)(基)(金)(的)(科)(学)(管)(理)(和)(使)(用)(,决)(定)(着)(支)(付)(改)(革)(能)(否)(顺)(利)(推)(进)(。前)(述)(人)(社)(部)(负)(责)(人)(也)(强)(调)(,作)(为)(配)(套)(政)(策)(,《意)(见)(》明)(确)(加)(强)(基)(金)(预)(算)(管)(理)(。按)(照)(以)(收)(定)(支)(、收)(支)(平)(衡)(、略)(有)(结)(余)(的)(原)(则)(,科)(学)(编)(制)(并)(严)(格)(执)(行)(医)(保)(基)(金)(收)(支)(预)(算)(。
根)(据)(《意)(见)(》要)(求)(,各)(地)(结)(合)(医)(保)(基)(金)(预)(算)(管)(理)(,完)(善)(总)(额)(控)(制)(,积)(极)(探)(索)(将)(点)(数)(法)(与)(预)(算)(管)(理)(、按)(病)(种)(付)(费)(等)(结)(合)(应)(用)(。各)(统)(筹)(地)(区)(要)(结)(合)(医)(保)(基)(金)(预)(算)(管)(理)(完)(善)(总)(额)(控)(制)(办)(法)(,提)(高)(总)(额)(控)(制)(指)(标)(的)(科)(学)(性)(、合)(理)(性)(。完)(善)(与)(总)(额)(控)(制)(相)(适)(应)(的)(考)(核)(评)(价)(体)(系)(和)(动)(态)(调)(整)(机)(制)(,对)(超)(总)(额)(控)(制)(指)(标)(的)(医)(疗)(机)(构)(合)(理)(增)(加)(的)(工)(作)(量)(,可)(根)(据)(考)(核)(情)(况)(按)(协)(议)(约)(定)(给)(予)(补)(偿)(,保)(证)(医)(疗)(机)(构)(正)(常)(运)(行)(。
医)(保)(基)(金)(对)(于)(医)(保)(支)(付)(的)(影)(响)(重)(大)(,涉)(及)(医)(院)(和)(医)(师)(诊)(疗)(行)(为)(规)(范)(的)(方)(方)(面)(面)(,国)(务)(院)(发)(展)(研)(究)(中)(心)(产)(业)(经)(济)(研)(究)(部)(研)(究)(员)(魏)(际)(刚)(在)(接)(受)(中)(国)(经)(济)(时)(报)(记)(者)(专)(访)(时)(曾)(指)(出)(,为)(限)(制)(院)(方)(逐)(利)(创)(收)(、医)(师)(开)(设)(大)(处)(方)(等)(可)(能)(导)(致)(医)(保)(基)(金)(被)(过)(度)(使)(用)(的)(行)(为)(,医)(保)(基)(金)(在)(使)(用)(门)(槛)(及)(报)(销)(比)(例)(上)(一)(直)(有)(着)(严)(格)(限)(制)(。他)(认)(为)(,为)(规)(范)(诊)(疗)(行)(为)(、预)(防)(过)(度)(医)(疗)(,医)(保)(基)(金)(首)(先)(明)(确)(了)(严)(格)(使)(用)(和)(节)(约)(使)(用)(的)(前)(提)(。这)(对)(抑)(制)(浪)(费)(、限)(制)(过)(度)(医)(疗)(有)(着)(积)(极)(功)(用)(。
但)(也)(不)(可)(否)(认)(,当)(前)(的)(医)(保)(支)(付)(的)(确)(存)(在)(着)(一)(系)(列)(亟)(待)(解)(决)(的)(问)(题)(,魏)(际)(刚)(说)(,门)(槛)(高)(、效)(率)(低)(以)(及)(异)(地)(支)(付)(等)(源)(于)(制)(度)(、机)(制)(上)(的)(壁)(垒)(,共)(同)(导)(致)(医)(保)(基)(金)(使)(用)(现)(状)(与)(其)(造)(福)(于)(民)(,且)(秉)(承)(“我)(为)(人)(人)(、人)(人)(为)(我)(”的)(政)(策)(初)(衷)(有)(所)(背)(离)(。因)(此)(,医)(保)(基)(金)(的)(使)(用)(最)(终)(还)(是)(要)(实)(现)(全)(覆)(盖)(、可)(持)(续)(、可)(支)(付)(,既)(不)(能)(过)(度)(透)(支)(,也)(不)(能)(持)(续)(结)(余)(过)(大)(,这)(是)(一)(个)(寻)(求)(平)(衡)(的)(过)(程)(。
对)(于)(如)(何)(提)(高)(医)(保)(基)(金)(使)(用)(效)(率)(,促)(进)(医)(保)(基)(金)(发)(挥)(更)(加)(高)(效)(、科)(学)(的)(保)(障)(作)(用)(,实)(现)(“有)(钱)(能)(花)(好)(”的)(目)(的)(,魏)(际)(刚)(认)(为)(,不)(断)(提)(升)(统)(筹)(层)(级)(对)(提)(升)(医)(保)(基)(金)(使)(用)(效)(率)(至)(关)(重)(要)(。当)(然)(,这)(还)(需)(要)(具)(体)(改)(革)(结)(合)(医)(保)(基)(金)(的)(使)(用)(逐)(步)(实)(现)(。比)(如)(,通)(过)(异)(地)(就)(医)(即)(时)(结)(算)(,逐)(步)(实)(现)(全)(国)(范)(围)(内)(的)(异)(地)(就)(医)(结)(算)(目)(标)(,尽)(量)(促)(成)(医)(保)(基)(金)(使)(用)(效)(率)(最)(大)(化)(;再)(如)(,通)(过)(统)(筹)(医)(保)(基)(金)(的)(高)(效)(利)(用)(,对)(相)(关)(改)(革)(的)(推)(进)(和)(实)(施)(形)(成)(配)(套)(支)(持)(,实)(现)(改)(革)(多)(方)(共)(赢)(。
显)(然)(,此)(次)(医)(保)(支)(付)(方)(式)(改)(革)(正)(需)(要)(医)(保)(基)(金)(的)(全)(面)(配)(合)(方)(可)(兑)(现)(改)(革)(承)(诺)(。结)(合)(医)(保)(支)(付)(方)(式)(改)(革)(,《意)(见)(》要)(求)(,有)(条)(件)(的)(地)(区)(可)(积)(极)(探)(索)(将)(点)(数)(法)(与)(预)(算)(总)(额)(管)(理)(、按)(病)(种)(付)(费)(等)(相)(结)(合)(,逐)(步)(使)(用)(区)(域)((或)(一)(定)(范)(围)(内)()医)(保)(基)(金)(总)(额)(控)(制)(代)(替)(具)(体)(医)(疗)(机)(构)(总)(额)(控)(制)(。采)(取)(点)(数)(法)(的)(地)(区)(确)(定)(本)(区)(域)((或)(一)(定)(范)(围)(内)()医)(保)(基)(金)(总)(额)(控)(制)(指)(标)(后)(,不)(再)(细)(化)(明)(确)(各)(医)(疗)(机)(构)(的)(总)(额)(控)(制)(指)(标)(,而)(是)(将)(项)(目)(、病)(种)(、床)(日)(等)(各)(种)(医)(疗)(服)(务)(的)(价)(值)(以)(一)(定)(点)(数)(体)(现)(,年)(底)(根)(据)(各)(医)(疗)(机)(构)(所)(提)(供)(服)(务)(的)(总)(点)(数)(以)(及)(地)(区)(医)(保)(基)(金)(支)(出)(预)(算)(指)(标)(,得)(出)(每)(个)(点)(的)(实)(际)(价)(值)(,按)(照)(各)(医)(疗)(机)(构)(实)(际)(点)(数)(付)(费)(,促)(进)(医)(疗)(机)(构)(之)(间)(分)(工)(协)(作)(、有)(序)(竞)(争)(和)(资)(源)(合)(理)(配)(置)(。返)(回)(搜)(狐)(,查)(看)(更)(多)(
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